Protothecal peritonitis in child after bone marrow transplantation: case report and literature review of paediatric cases

Abstract

The case presented here illustrates a protothecal infection caused by Prototheca wickerhamii in a paediatric haematopoietic stem cell recipient followed by a review of the literature of all 13 paediatric cases published since 1980. Protothecosis is a rare disease caused by algae, not described in this setting before. Infection was proven additionally post-mortem from peritoneal dialysis fluid. Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents. Prototheca spp. show various susceptibility profiles, and there is no direct correlation between in vitro activity and clinical response. There are different treatment regimens described but there are no clear published guidelines of specific therapy of protothecosis. Paediatric cases were successfully treated mostly with amphotericin B and azoles. As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

Prototheca wickerhamii breast implant infection after reconstructive surgery: a new level of complexity

“…Devices and prostheses implicated in protothecosis included Tenckhoff catheters (5 cases) [ [21] , [22] , [23] , [24] , [25] ], Hickman lines or central venous catheters (4 cases) [ 4 , [26] , [27] , [28] ], VP shunts (3 cases) [ 7 , 29 , 30 ], keratoplasties (2 cases) [ 5 , 6 ] and an endotracheal tube (1 case) [ 31 ]. In most patients the source of infection was unknown, however in two cases of protothecal peritonitis involving Tenckhoff catheters, water exposure at a municipal swimming pool [ 22 ] and a river [ 23 ] were environmental risk factors.…”

Successful treatment of cutaneous protothecosis with liposomal amphotericin and oral itraconazole

“…A wide range of systemic manifestations has been reported, including abdominal infections, pneumonia, bloodstream infection and central nervous system infection [2] , [9] , [10] , [11] . Peritoneal catheter and other device infections are also described [2] , [12] , [13] . Disseminated disease is reported generally in the immunosuppressed, frequently with exogenous steroid use, as with this case [2] .…”

Protothecal bursitis after simultaneous kidney/liver transplantation: a case report and review

“…At least 3 cases have been reported where the infection caused cholestatic hepatitis . Less frequent presentations are lymphadenitis and urinary tract and central nervous system infections in immunocompetent hosts and peritonitis in patients undergoing peritoneal dialysis and HSCT .…”